New methodsClinical endoscopyMetallic coil and N-butyl-2-cyanoacrylate for closure of pancreatic duct leak (with video)
Section snippets
Clinical history
A 47-year-old man presented to the Los Angeles County Hospital with a gunshot wound to the abdomen complicated by hypotension because of suspected hemorrhage. He emergently underwent exploratory laparotomy, during which he was found to have active bleeding of the infrarenal inferior vena cava and injury to the superior mesenteric artery, duodenum, stomach, left lobe of the liver, and the pancreatic tail with evidence of severe parenchymal injury and main duct transection. He underwent primary
Results
The patient did not develop increased upper abdominal discomfort or serum amylase or lipase levels in the postprocedure period. JP drain output decreased steadily. At 1 week postprocedure, JP drainage decreased to <30 mL/day and the amylase and lipase levels normalized at 44 U/L and 9 U/L, respectively. He had no further clinical signs or symptoms of pancreatic fistula. The patient was started successfully on an oral diet and was eventually discharged home. The pancreatic duct stent was removed
Discussion
Pancreatic fistulae frequently respond to conservative management with bowel rest, total parenteral nutrition, and treatment with somatostatin analogues.9 When conservative management fails, placement of a transpapillary pancreatic stent to promote antegrade flow is often successful.10 Leaks refractory to pancreas stent therapy are not infrequent and can be difficult to manage. Stent malfunction, occlusion, or migration should always be considered before progressing to more aggressive
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Cited by (4)
Chiral D-peptide supramolecular hydrogel for minimizing postoperative pancreatic fistula by devitalizing pancreatic enzymes
2024, Chemical Engineering JournalEndoscopic Retrograde Cholangiopancreatography for the Management of Pancreatic Duct Leaks and Fistulas
2024, Gastrointestinal Endoscopy Clinics of North AmericaChinese expert consensus on the endoscopic diagnosis and treatment for pancreatic fistula (2020, Beijing)
2021, Chinese Journal of Digestive Endoscopy
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
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